3.2 Study setting and rationale

The study will be carried out at Kiruddu National Referral Hospital. Kiruddu National Referral Hospital is located on Buziga Hill, in Makindye division along Salaama – Munyonyo road, one of the five administrative units of the Kampala Capital City Authority. It is approximately 13.5 kilometers (8 mi), by road, south-east of the Mulago National Referral Hospital. Kiruddu National Referral Hospital is approximately 10 kilometers (6 mi), southeast of the central business district of the city.  The coordinates of Kiruddu General Hospital are 0°14’53.0″N, 32°36’45.0″E (Latitude: 0.248056; Longitude: 32.612500). Kiruddu National Referral Hospital has a total number of 120 permanently employed nurses of all cadres; certificate level, diploma and degree level. Kiruddu offers has critical care units like accident and emergency, highly dependent unit, and intensive care unit with cardiology, pulmonary, renal, burns and plastic, dental services, burns and plastics and psychiatric services which will be able to meet the study need of nurses working in critical care unit.

3.3 Study population

The study population will include 35 nurses working in critical care units ICU,HDU and Emmergency units at Kiruddu National Referral Hospital.

3.4 Sample size determination

The study will consider a sample size of 32 nurses considering who qualify and are willing to consent and participate in the study considering the Krejcie and Morgan table.

3.4.1 Sampling procedure

The researcher will use simple random sampling to collect data until the required number of participants are achieved. The researcher will assign numbers to all available nurses working in critical care unit. All those who will pick number one to thirty will qualify for the study.

3.4.2 Inclusion criteria

All nurses working in critical care unit for a period of 1 year and above who are willing to be part of the study and have consented to participate in the study will be included.

3.4.3 Exclusion criteria

Nurses working in critical care units but are not willing to consent will be excluded from the study.

Nurses working in critical care units who will be on leave will be excluded from the study.

3.5 Definition of variables

 3.5.1 Independent variable

The determinants of stress among nurses working in critical care units.

3.5.2 Dependent variables

Stress among nurses working in critical care units

3.6 Research instruments

The researcher will collect data using 2 questionnaires. The first questionnaire will test for the determinants of stress and that will consist of a set of closed ended questions on the study objectives. This will help to obtain firsthand information and a quick and easy way to record and identify data and requirements for the study.

Secondly to collect data for the levels of stress the researcher will use the Patient Health Questionnaire (PHQ9). Patient Health Questionnaire-9 is a self-administered tool used to screen, diagnose, monitor, and measure depression severity. It consists of nine items assessing depressive symptoms frequency over two weeks, with higher scores indicating greater severity(Sun et al., 2020).  The PHQ-9, designed to assess depression, can also be used to evaluate stress levels among nursing staff, as elevated scores may indicate underlying stress-related issues. Research in Kenya demonstrated its reliability and validity(Odero et al., 2023). In practice, the PHQ-9 can be administered to nursing staff to identify those experiencing depressive symptoms, which may be indicative of high stress levels.

3. 7 Data collection procedures

The researcher will obtain an introductory letter from the school to seek permission to carry out the study from the Director of Kiruddu National Referral Hospital. The director of Kiruddu National Referral Hospital is expected to write to the ward in charges of all critical care units to give all the necessary help to the researcher regarding this study especially with data collection.

The ward in charges will assign any healthcare worker the duty of introducing the researcher to nurses in critical care units. The researcher will then seek consent from the able nurses to participate in the study and they will be enrolled into the study upon their consent to participate by answering the questions in the questionnaires and they shall be appreciated for their participation.

3.7.1 Data management

Data will be managed by the researcher to ensure accuracy, confidentiality and security. The researcher will also check for the completeness of the data and will be hand-coded and entered into Microsoft Excel. The data will then be exported to Stata 15 version software for further cleaning. Cleaning of the data will be done by running frequencies on each variable. This will check inconsistently coded data. Inconsistently coded data will be double-checked with raw data from the check list, and all inconsistencies and errors will be resolved. A completed check list will be stored in safety lockers under lock and key. They will only be accessed by the researcher so that the acquired information isn’t manipulated by other people for selfish interests.

3.7.2 Data Analysis

Data will first be cleaned, coded and categorized according to the specific objectives. This data will manually be entered into Statistical Package for Social Scientists (SPSS) software version. Descriptive data will be run in this program to develop graphs and charts for better interpretation of the findings. These will be transferred to Microsoft word where data will be interpreted in a narrative form to illustrate the basic meaning of the results.

3.8 Ethical Consideration

The research proposal will be reviewed by the supervisor and will then be submitted to the Research ethics committee for approval. An introductory letter will be written from the school introducing the researcher to the study area managers. The researcher will take the introductory letter and the approved proposal to the health facility director to seek permission to carry out the research data collection in their facility. The area managers, ward in charges and the nurses of the respective critical care unit will also be notified about the study. The collected data will be kept under lock and key only accessible by the researchers.

3.9 Limitation of the Study

The study may face;

• Critical care nurses are often overworked and may be hesitant to participate in research studies however, as the researcher, I will clearly communicate the purpose and benefits of the study and be flexible with the participants’ busy schedules.
• The researcher also expects to get inadequate information which is due to the sensitivity of the study topic but will explain properly to the participants and reassure them of full confidentiality, no harm, blame or even identity.

3.09 Dissemination of results

The findings of this research study will be made into a research dissertation where copies will be produced and submitted to different stakeholders as follows;

• Uganda nurses and midwives’ examination board as partial fulfillment for the award of a Diploma in Nursing
• Aga Khan University for future reference by other researcher, scholars and students.
• Kiruddu National Referral Hospital management in order to plan on how to create solutions for the identified gaps.
• The researcher will also have a copy for personal references.
• Presentation in conferences especially the Nurse’s led conferences.

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APPENDICES

APPENDIX I: INFORMED CONSENT TO PARTICIPATE IN THE STUDY

Dear respondent, my name is Nakaye Phoebe. I am a student at Aga Khan University pursuing Diploma in Nursing. As a course requirement to complete my study program, a research study should be carried out. I am therefore requesting you to be part of my study titled; “Identifying the determinants of stress among nurses working in critical care units at Kiruddu National Referral Hospital, Kampala Uganda”. All information that will be given to me is assured confidentiality and will be treated and strictly used for academic research purposes and incase of any questions about the study or the consent document, please ask before signing, and I will do my best to answer them. If you agree to participate in this research, you will be given a questionnaire that will require you to answer each question appropriately. You are required to tick the most appropriate alternative and the interview will take 5-10 minutes.

Benefits and risk of the study

This study will assist the facility to improve on work related stress in the critical care units among nurses. The only risk is on time consumption, as it will require some of your time to complete the questions.

I …………………………………, have read the above informed consent document and understood the information provided to me regarding participation in the study and benefits. I give consent to take part in the study.

Signature of the respondent …………………………………. Date ………………

Thump print ……………………………………………………………………………

Signature of researcher:…………………………………………………

Date: ………………………………………………

APPENDIX II: QUESTIONAIRE

This questionnaire is purely designed to determine “Identifying the determinants and levels of stress among nurses working in critical care units at Kiruddu National Referral Hospital, Kampala Uganda”. All the information collected will be kept confidential. To answer the question, put a tick inside the box in line with the most correct letter on the objective.

SECTION A: Socio- demographic data of the respondent

Instruction: Tick only what applies

Q01. What is your gender?

1. Male
2. Female

Q02. How old are you?

1. 18-25
2. 26-35
3. 36-49
4. 50 and above

Q03. What is your level of education?

1. Certificate
2. Diploma
3. Degree
4. Masters

Q04. What is your religion?

1. Catholic
2. Moslem
3. Protestant
4. Born again

Q06. What is your marital status?

1. Married
2. Divorced/separated
3. Single
4. Widow/widower

Q07. Which one is your unit of work

1. Accident and emergency unit
2. Highly dependent unit
3. intensive care unit

SECTION A: RESEARCH QUESTION ONE

Determining the level of stress among nurses working in critical care unit

Over the last 2 weeks how often have you been bothered by any of the following problems?

Please indicate your response with a ✔ against the statement on the left-hand side.

PHQ-9

SECTION B: RESEARCH QUESTION TWO

Find-out the causes of stress among nurses working in critical care units

1. Do you work in shifts?
2. Yes
3. No
4. What shift do you have?
5. Morning, Evening and night
6. Day and night only
7. Day shift only
8. For how many hours do you work per shift?
9. 6 hours
10. 8 hours
11. 12 hours
12. 24 hours
13. Which shift do you find so hectic to cover?
14. Day shift (12hours)
15. Morning shift (8hours)
16. Evening shift (6 hours)
17. Night shift (12hours)

Please indicate your level of agreement using this scale in the table below:

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Thank u for your participation

APPENDIX 111 Sampling Determination Table

APPENDIX IV  RESEARCH BUDGET

APPENDIX V: RESEARCH WORK PLAN